Geriatrics

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Geriatrics2017-09-07T21:39:23+00:00

Geriatrics

It’s not a little ironic that the study of the old is relatively new. 

geriatrics couch image from New Medical Terms

Geriatrics, or the joys of aging

The name geriatrics (geras, old age and iatrikos, physician) was coined in 1909 by Ignatz Nascher (1863-1944), an Austrian-American physician who is the widely acknowledged father of the field. He regarded old age as a distinct physiologic stage of life, analogous to childhood, challenging the then extant pathological model of aging championed by Nobel Laureate Elie Metchnikoff and others. Metchnikoff believed that aging was caused by tissue phagocytosis and so-called autointoxication—absorption of intestinal decompositions, for which he prescribed yoghurt. Metchnikoff’s model later proved naive and management quaint (read, ineffective). 

One explanation why geriatrics is a late arrival as a medical specialty is that in the past, few made it much beyond a half century…so there weren’t a lot of old people to study. According to data from the CDC*, the average number of years that a person born in 1900 lived, was 48 for a man and 49 for a woman…which is to say, grandparenting was a short-lived hobby in the era. 

*Centers for Disease Control and Prevention. 

Things improved substantially in the intervening century—assuming a longer lifespan is an improvement. On average, a man born in 2003 is expected to live 75 years, a woman, 77, besting the 20th century’s lifespan by nearly 30 years. However, adding three decades to an aging chassis has consequences: metabolism slows, neurons misfire, hearing deteriorates, sight fails, memories fade, libido falls, teeth fall out, arteries harden, muscles atrophy, bones break; and they often drool and dribble…the latter of which explains the scent Eau d’Old*.

geriatric running Image from New Medical Terms

Elders staying in shape

*Don’t look for it at the perfume counter

In dealing with septuagenarians, it becomes clear that absent setting older elders on ice à la Inuit, one’s old will need medical care until they …go gentle into that good night. That care is best provided by doctors who are trained to deal with the doddering. Major take-home points in geriatrics are:

(1) Diseases present differently in older than in younger patients,  

(2) Medicines can exacerbate morbidities and have unexpected effects due to age-related changes in metabolism, and 

(3) Maintaining a healthy lifestyle–i.e., smoking cessation, Asian or Mediterranean diet, regular aerobic and weight-training exercise, offers greater benefits than polypharmacy

References

European Geriatric Medicine 2012; 3:225-227

https://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_14.pdf